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The right to health is enshrined in Articles 196 to 200 of Brazil’s 1988 Constitution. Consequently, the system is designed to ensure access to healthcare services to every resident, and entitlement is universal. Such universality makes Brazil quite different from its Latin American neighbours.
The right to health is meant to be achieved by the Unified Health System (Sistema Único de Saúde – SUS), rather than the private sector. Technically speaking, it is a taxpayer-funded system that provides free health services through public sector hospitals and establishments.
Prior to 1988, Brazil had an insurance-based system, but this caused many low-income Brazilians to be uninsured or with poor coverage. Just like Italy, Brazil has eventually decided to shift to a tax-financed system.
In practice, the Unified Health System does not always ensure the service quality it wants to provide. Additionally, the system shows considerably more inequalities than it first seems.
Generally, the Unified Health System is designed for primary healthcare services, as well as emergency care. It is in fact quite residual, as it accounts for only 3% of GDP (by contrast, the UK Government spends about 8% of GDP on its National Health Service). As a result, public hospitals in Brazil are largely overcrowded and understaffed, not to mention the equipment and the hospital infection risks.
In Brazil, the upper middle class – and by extension, many expats – tends to prefer relying on the private sector. This is generally because of shorter waiting times. The need to find the most experienced doctors and better equipment may be an issue as well, but a public hospital may reasonably be given preference in an emergency.
The net result is that about 60% of Brazil’s total healthcare expenditures come from the private sector.
As mentioned above, private healthcare provision in Brazil is still predominant. This is likely to gradually change though, as Brazil’s economic growth allows for more aspirations from Brazilian citizens. As in most developing countries, this is ultimately meant to increase the share of Government spending as a percentage of GDP. This demand for more public services is particularly strong for healthcare.
Recent experience has shown some gradual improvements in the public system. The Government has more public funds available, which helps finance much-needed healthcare programmes. Brazilians are getting healthier as well, as the life expectancy rate has now reached 75 years (over 80 in Western Europe).
As far as infant mortality is concerned, the rate now stands at 13 per 1,000 births, down from 52 in 1990. By contrast, the UK shows a rate of 4 per 1,000 births.
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